🚀 go-pugleaf

In article <28hfek$mph@apakabar.cc.columbia.edu> gld@mhoro.cc.columbia.edu (Gary L Dare) writes:
>
>If you can afford it, you'd not be in the plan you're stuck in.  Can
>you opt out of your employer's HMO, whether or not you can take the
>equivalent in cash, to buy your own fee-for-service plan?

Yes, in a way.

Some companies offer what is known as a "cafeteria plan" (I don't know from
whence the name comes) where you can set aside X percentage of your pre-tax
income for health services. You can then use this income to pay directly
for your services on a fee-for-service schedule. If you use up all of your
allocation, great! You've just been able to reduce your 1040 line 10 income
right off the top, possibly lowering yourself into a lower tax bracket.

However, if you don't use all the money you set aside in your plan by the
end of the year, Uncle Sam just wraps his mitt around this and says "Thank
you." You lose it, straight out.

>I thought not.

Yes, you can. You have to have a company with a sharp (and benevolent)
accountant, much as many companies offer 401K plans on the whim of their
accounting departments. Granted, not many companies do this, but the point
it that there is a provision for doing this, it does work for people who
can easily predict a constant level of medical expense (people with
children seem to use the plan the most) and it is an alternative.

>And health costs now are such that getting access outside of
>your present plan (esp. HMO) is already impossible

No, not so.

If I wanted to go completely outside my company's health plan, I could buy
major medical insurance via the IEEE or ACM. It would cost me $800 to $1000
per year, might not have all the goodies that my current plan has, but it
would cover major expenses and emergency coverage. 

Now, here's an idea I'd like to float past people:

Let's say that instead of taxing people to provide for health care, that
the government set up something like a 401K for health care costs. ie, you
could set aside X% of your pre-tax income for health-care costs; the
government could dictate a minimum you must save. The savings plan would be
administered by your employer, just as a 401K is.

You could not withdraw from the plan unless you could prove you have
alternative coverage. You could direct the investment option you want for
unspent contributions to the plan, within reason. You would get your income
reduced by the amount of your yearly contribution. You could not spend
money out of the plan _except_ for health care costs.

Your plan would be carried around like the contributions to a 401K -- ie,
when you move from employer to employer, you would transfer your account
into the new employer's plan. If you're leaving the workforce, you would
have to transfer your money into a self-directed plan, subject to
government oversight. (not control, oversight).

At the end of each year, the government takes 50% of the gains from the
investment on everyone's plan to pay for the uninsured.

The current insurance industry is basically tossed out on its ear and the
pricing structure of health care is reformed so that people are getting
what they pay for. (If individuals who obtain services from the health-care
industry actually had to review and pay the bills, there would be a whole
lot less cost-shifting and a whole lot more accountability for costs than
there is now).

If you die and there are funds left in your account, Uncle Sam takes them
for the uninsured account. But if you need health care after you retire,
there's a fund of your own money sitting there ready for your use.

I see this possibility as solving several problems in one stroke:

1) It keeps the government out of the health care process -- people still
   choose their doctor. 
2) There would be a growing pool of savings out there. The rate of American
   savings is abysmal as it is, and this could help augment FICA for
   people's old age; the biggest expense for most geriatrics is health care.
3) It contributes towards the uninsured, which is supposed to be the 
   whole point of this health-care exercise, right?
4) The insurance companies have their leashes yanked real hard; there 
   is suddenly a viable alternative with an incentive to siphon money
   away from the classic health insurance industry. Nothing like some
   competition to wake 'em up.
5) The reduction in line 10 income  provides an incentive for the well-off
   to contribute to the plan to obtain the tax break.

I haven't run any numbers on this, but I think it sounds better than the
social engineering nonsense coming out of Washington, where they're not
only trying to devise a health-care plan, but an entire social agenda...
(abortion, gun control, violence, tax distributions, sin taxes and on and on)

The problem with the Clinton(s) (yea, both of 'em) is that they only know
how to use the stick. They don't even know a carrot exists.

Hell, want to add some more incentive to it? Run out some actuarial
numbers; if you've been good to yourself and you've attained certain
milestone ages and have 'x' amount in your account and you receive a good
clean bill of health, allow you to pull some income out of the investment
return (not the principle). This would add incentive to keep yourself
healthy.


dsa